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General NPI Number Information
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NPI Number | 1174199095
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Entity Type | Organization
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Legal Business Name | TALLE REGEN, LLC
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Dates
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Enumeration Date | 06/01/2021
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Last Update Date | 06/01/2021
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Provider Practice Location Address
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Address Line | 1641 MAHAN CENTER BLVD STE 2
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City | TALLAHASSEE
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State | FL
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Zip | 32308-7404
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Country | US
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Telephone | 615-952-0106
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Fax |
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Provider Business Mailing Address
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Address Line | 4007 W 27TH CT
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City | PANAMA CITY
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State | FL
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Zip | 32405-1211
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Country | US
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Telephone | 615-952-0106
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | MR. JAMES JEFFREY ADAMS
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Credential |
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Telephone | 615-952-0106
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number |
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License Number State |
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